APPLICATION FOR HEARING ON EXEMPT STATUS OF FUNDS
JD-CV-72 New 2-02 C.G.S §52-367b, P.A. 01-196
CONNECTICUT JUDICIAL BRANCH
COURT USE ONLY
Attach a copy of form JD-CV-73, "Affidavit Re: Exempt Funds" authorizing this application. Complete the following application and present to the clerk of the court where the action is pending.
DOCKET NO. NAME OF CASE (FIRST-NAMED PLAINTIFF V. FIRST-NAMED DEFENDANT) NAME OF JUDGMENT CREDITOR AMOUNT OF FUNDS CLAIMED AS NOT EXEMPT TYPE OF FUNDS NAME OF JUDGMENT DEBTOR
Judicial District at:
Small Claims Area at:
Housing Session at:
APPLICATION FOR HEARING ON EXEMPT STATUS OF FUNDS Pursuant to the attached order of the court (form JD-CV-73), the above-named judgment creditor submits this application for a hearing on the exempt status of the funds identified above that were left in the judgment debtor's account pursuant to subsection (c) of C.G.S. § 52-367b, as amended by section 1 of Public Act 01-196.
SIGNED (Individual attorney or pro se party) DATE
I hereby certify that a copy was mailed/delivered to all counsel and pro se parties of record on:
NAME OF EACH PARTY SERVED * DATE
CERTIFICATE OF SERVICE
SIGNED (Individual attorney or pro se party) PHONE NO. (area code first)
ADDRESS AT WHICH SERVICE WAS MADE*
* If necessary, attach additional sheet with names of each party served and the address at which service was made.
COURT ORDER (For Court Use Only) The court having heard the above application finds:
FOR COURT USE ONLY